Provider Demographics
NPI:1699973917
Name:ELLIOTT, ZANA (FNP)
Entity type:Individual
Prefix:
First Name:ZANA
Middle Name:
Last Name:ELLIOTT
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12751 WESTBROOK DR
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75704-2458
Mailing Address - Country:US
Mailing Address - Phone:903-266-1599
Mailing Address - Fax:903-266-1589
Practice Address - Street 1:967 PRUITT PL
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75703-1153
Practice Address - Country:US
Practice Address - Phone:903-266-1599
Practice Address - Fax:903-266-1589
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-08
Last Update Date:2013-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX738885363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily